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M . <br /> CHAIN OF CUSTODY/LABORAA RY ANALYSIS REQUEST FORM <br /> SHAW Environmental&Infrastructure,Inc. 40 M 4r <br /> Purchase Order 3648 <br /> 1326 North Market Boulevard Sacramento CA 95834 Lab STL/Quanterra,W.Sacto <br /> Project Name Don Rodgers Anal sis Requested <br /> GlobaIID- T0607700717 <br /> Project Number 8800391A/01010000 <br /> Project Manager David Herzog = .. <br /> Company SHAW Environmental&Infrastructure,Inc. N <br /> Address 1326 North Market Boulevard 0 <br /> Sacramento,CA 5834 Q <br /> 4. m <br /> Dir Ph 916-565-4377 / F 916- 65-43 0 <br /> x <br /> Sampler's Signature z REMARKS <br /> Sample LAB Sample 1 IContmner Types <br /> I D Date Time ID Matrix HCI Preservations <br /> MW-1R water 3 3 <br /> MW-3R water 3 3 <br /> MW-4RS 'i <br /> water 3 3 <br /> MW=4RD water 3 3 <br /> VW-11) O`u water 3 3 <br /> VW-2D IO t`1 water 3 3 <br /> VW-3D $3f water 3 3 <br /> VW4 Sel water 3 3 <br /> RELINQUISHED BY RECEIVED BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X I Routine Report <br /> Sr Si / Signature Signature 24 hr 4e bt 5 day II Report(includes DUP,MS <br /> X Snad,;(-10.15 w-kms dws) MSD,as requited,may be <br /> Plaine Pnnted Name Printed Name Printed Name Promde va bd Prelimmary Rains charged as samples) <br /> r7wC' � PrwndeFAX PmhmuwyRmlft III.Dam Validation Report <br /> Fls 1lTW r fi Firm Firm Fum ReQeamd Rgmn Due (includes All Raw Data) <br /> E <br /> RWQCB <br /> DatP1rxme -'o Datefrmie DateMne DaWrime 0,IDLs/PQWM,e,CE#) <br /> RELINQUISHED-BY RECEIVED BY Special Instnrcbons/Comments Container Types Key <br /> 40 rid VOA 1 <br /> Signature Signature STL/Quanterm 125 ml LPE 2 <br /> Need EDDs for GeoTracker 880 Riverside Parkway 500 ml LPE 3 <br /> Printed Name Printed Name Report to the P M.in PDF format,please- W Sacto,Calif 95604 1 liter HDPE 4 <br /> _David HerzoaQShawgXp com 916-373-5600/Fx 372-1059 500 ml glass 5 <br /> Fam Firm Contact Jon Ciddersleeve 1 liter glass 6 <br /> 2x6 s!s ring 7 <br /> Dam(rime Date/I'1me Shaw sample coord Sheila 916-565-4327 <br /> glass�ar 8 <br />